CIRCUIT COURT OF CLAY COUNTY, MISSOURI PROBATE DIVISION No.__________________ Matter of _______________________________________, deceased. APPLICATION FOR APPROVAL OF FINAL SETTLEMENT AND FOR ORDER CLOSING ESTATE, ASSETS EXHAUSTED As Personal Representative of the above estate I hereby state to the Court: That this estate is in a proper condition to be closed; that all assets have been applied to the payment of debts and expenses and are exhausted and; that there are no assets to be distributed. Wherefore, I request that the Final Settlement be approved; that this estate be closed; that I be discharged as Personal Representative and; that I and the surety on my bond be released from further liability. THE STATEMENTS AND REPRESENTATIONS IN THIS DOCUMENT ARE MADE UNDER OATH AND ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THEY ARE MADE SUBJECT TO THE PENALTIES OF MAKING A FALSE AFFIDAVIT OR DECLARATION. Date__________________ __________________________________________ Personal Representative ORDER APPROVING SETTLEMENT AND CLOSING ESTATE, ASSETS EXHAUSTED. On this _____ day of _________________________, the Court considers the Final settlement and application to close the estate filed by the Personal Representative and the Court finds that there are no assets for distribution and the application should be granted. WHEREFORE, it is ordered that the Final Settlement is approved, the estate closed and, the further liability of the principal and surety on the bond is terminated. JUDGE Form 546-D Revised 3/17/2003 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com